Background: New procedures in endoscopy take time to be incorporated in the German diagnosis-related groups (DRG) system. Depending on the extent of innovation and the costs, several pathways are possible. Methods: This article provides an overview of possible pathways to implement new procedures in the German DRG payment system. Additionally, we compare the results of 2 surveys on the system of New Diagnostic and Treatment Methods (Neue Untersuchungs- und Behandlungsmethoden; NUB). Furthermore, the pathways of 2 innovations in endoscopy are described in detail and compared with the possibilities within the legal framework. Results: The different pathways like NUB applications or DRG change requests and the underlying legal framework are described in detail. The results of a survey from 2007 on the daily practice of NUB funding in Germany show that the extent of innovations which receive a positive assessment (status 1) is 46% compared to 43.7% in a survey from 2007, and that 77% of the status 1 procedures (and drugs) can be negotiated into a payment - compared to 53% in the older survey. Conclusion: Medical scientific societies should be involved in this process from the beginning. Besides the importance for the hospital application process (81.3% of all medical controllers want to have society support), the regulatory bodies (e.g. DIMDI, InEK, G-BA) also appreciate scientific statements. Two examples show the pathways in detail. For radiofrequency ablation of Barrett's esophagus, the pathway of continuous change requests was chosen, while the endoluminal conduit for the treatment of type 2 diabetes was established as NUB payment.